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Australia

The Euthanasia Laws Act 1997 passed by the Commonwealth Parliament prohibits euthanasia and assisted suicide in the Northern Territory, Australian Capital Territory and Norfolk Island.

State legislatures can make their own laws on this issue, and many attempts have been made to legalise assisted suicide in several states. All have failed.

Belgium

Belgium’s Euthanasia Act 2002 says that only doctors can administer lethal drugs with the intention of ending life after the person has made an explicit request. The law was amended in 2014 to remove age limits, so that children can now be legally euthanised.

What the law says is bad enough: the practice is much worse.

Without Consent

Professor Cohen-Almagor of the University of Hull, in a paper published in the Journal of Medical Ethics, says that 1.7% of all deaths in Belgium in 2013 were caused by life-ending drugs “with the intention to shorten life and without explicit request”.

In 52.7 percent of these cases, the patients were 80 years of age or older. The decision to euthanize was not discussed with the patient in 77.9 percent of the cases because he/she was comatose, had dementia, or “because discussion would have been harmful to the patient’s best interest,” according to the study.

Be careful not to have an accident in Belgium

The Belgian Society of Intensive Care Doctors published a statement in 2013 about dealing with dying patients in Intensive Care Units. Their ten points included:

The plans for end-of-life care in each individual patient should be discussed with and understood by the relatives (or the patient’s surrogate if one has been appointed). However, it must be made clear that the final decision is made by the care team and not by the relatives.

Shortening the dying process with use of medication, such as analgesics/sedatives, may sometimes be appropriate, even in the absence of discomfort, and can actually improve the quality of dying; this approach can also help relatives accompany their loved one through the dying process—such a decision should be made with due consideration for the wishes of family members.

Through the entire process, the intention must not be interpreted as killing but as a humane act to accompany the patient at the end of his/her life.

The present document applies to children as well as to adults

Canada

On 6 February 2015 the Canadian Supreme Court ruled that a blanket ban on euthanasia and assisted suicide was contrary to the Canadian Charter of Rights and Freedoms because it was “overly broad”. It required the Canadian Parliament to establish a regulatory regime within 12 months.

The Court’s judgment is the start of a process, rather than the end, as an editorial in Macleans observed:

Let’s try admitting it to each other: it is not easy to say whether the Supreme Court of Canada’s ruling wiping out Criminal Code provisions forbidding assisted suicide will turn out to be the right one, outcome-wise. The court, after all, did not prescribe an ultimate outcome. It struck down an absolute rule it found to be “overbroad” in its effects. Legislators, it said unanimously, need to design a regime for doctor-assisted death that allows “competent adults . . . suffering intolerably as a result of a grievous and irremediable medical condition” to have access to it.

But the justices did not say much about what principles the new rules need to follow, assuming that there must be some limits on access to active medically administered suicide. Some desirable restrictions are implied in words like “competent” and “adult” and “intolerably” and “grievous,” but the court didn’t go into any detail about the meanings of those terms.

The Netherlands

Euthanasia and assisted suicide was legalised by the Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2002.

Statistics Netherlands reports that in 2010 4,360 people died as a result of euthanasia or assisted suicide. Of these, 310 people had made no explicit request. It is likely that these numbers are significantly under-reported.

NVVE is the leading proponent of euthanasia and assisted suicide in the Netherlands. In March 2012 it opened the Levenseindekliniek, the “end of life clinic.”

It serves as a point of contact for all Dutch people who want to die but don’t have a primary care physician prepared to help them do so. The clinic has mobile euthanasia teams, each of which consists of a doctor and a nurse. When an individual qualifies for the program after passing a screening, one of the teams makes a house call to inject two drugs.

{NVVE director] Petra De Jong says the new clinic has also been created to fulfill the death wishes of individuals who are not terminally ill

The NVVE intends to continue fighting for the legalization of assisted suicide in the Netherlands. Thousands of people call the association’s office every year because they want to die and are looking for advice. NVVE staff members don’t try to talk any of them out of killing themselves. “It’s not our job,” de Jong says. “It would be paternalistic.”

Instead, the callers are provided with information on how to ensure that their suicide attempts succeed.

The NVVE is now advocating that anybody over the age of 70 who is tired of living should have access to a “suicide pill”.

Professor Theo Boer supported the legislation and was a member of

I used to be a supporter of legislation. But now, with twelve years of experience, I take a different view.

United States of America

Compassion & Choices is the leading proponent of assisted suicide in the United States. It was formed in 2003 by a merger of Compassion in Dying and the Hemlock Society.

Revenues of US$17.1 million in 2013/14, 71 full-time employees.

In 2008 C&C doctors provided 88% of all lethal prescription deaths in Oregon.

Kathryn Tucker was C&C’s long-time legal affairs director. In 2014 her appointment as Executive Director of the Disability Rights Legal Center was met with dismay by other disability rights groups.

In early 2015 Ms Tucker visited New Zealand, and co-authored articles with University of Otago law professor Andrew Geddis.

Six people associated with C&C provided affidavits for the plaintiff in Seales v Attorney-General.

An October 2015 article in the Southern Medical Journal (‘How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?’) provides the first academic analysis of the impact of assisted suicide legalisation on overall suicide rates in Oregon, Washington and Vermont. It concluded that such laws resulted in a 6.3% increase in suicide rates.

Drawing on resources from the social learning theory, Stack and Kposowa demonstrate that ‘‘persons socialized in nations with relatively high rates of suicide are more likely to be exposed to suicidal role models, which provide positive definitions of suicide.’’ Such mechanisms increase the level of individual approval of suicide and therefore reinforce the high rate of suicide within the culture. This is analogous to the effect of media reporting that ‘‘normalizes’’ suicide. It may be that legalizing PAS also provides positive role models who help normalize suicide more generally.

Oregon

The first state to pass legislation allowing assisted suicide, taking effect in 1998.

a 28% increase in lethal prescriptions over 2013
a 44% increase in deaths over 2013
only 2.9% of applicants were referred for psychiatric evaluation
87% cited “Less able to engage in activities making life enjoyable” as a reason for their request
40% cited “Burden on family, friends/caregivers” as a reason for their request

The law requires that the lethal prescription is only available to a person with a life expectancy of 6 months. Since 1988:

the longest period between the first request and actual death was 1009 days (2 years 8 months)

22 people have regurgitated the lethal drugs when they were administered, and 6 people have regained consciousness.

the average length of the doctor-patient relationship was just 13 weeks (3 months).

California

The End of Life Option Act was passed 44 – 35 by the Assembly on 9 September 2015, and passed 23 – 15 by the Senate on 11 September 2015.

Governor Jerry Brown signed the bill on 5 October 2015 despite a personal plea from Not Dead Yet’s Diane Coleman:

as a person who has been disabled all of my life, I’ve learned that some of the health care that I’ve needed will not be covered by the available forms of insurance, because it won’t cure me and it “costs too much”, things that would have helped me maintain more physical function longer or reduced the help I needed from family. This is a common experience in the disability community. The idea of mixing a cost-cutting “treatment” such as assisted suicide into a cost-conscious health care system that’s poorly designed to meet a seriously ill patient’s needs is dangerous to the thousands of people whose health care costs the most — mainly people living with a disability, the elderly and chronically ill. It doesn’t increase my comfort to know that the California Medical Association has gone neutral. When push comes to shove over the health care needs of a disabled Californian, whose corner will the doctor be in? These realities undermine the image of “choice” that is being sold by assisted suicide advocates.

The law will come into effect on 1 January 2016.

United Kingdom

Scotland

On 27 May 2015 the Scottish Parliament defeated an assisted suicide bill by 82 votes to 36 votes.

The select committee considering the Bill concluded:

The Committee is not persuaded by the argument that the lack of certainty in the existing law on assisted suicide makes it desirable to legislate to permit assisted suicide; it considers that the law must continue to provide an effective deterrent against abuse, and to be responsive to the individual facts of particular cases.
The Committee acknowledges that there are ways of responding to suffering (such as increased focus on palliative care and on supporting those with disabilities), which do not raise the kind of concerns about crossing a legal and ethical Rubicon that are raised by assisted suicide.
Given the qualified nature of the principle of respect for autonomy, and the need to weigh it against other relevant legal and ethical principles, the Committee is not persuaded that the principle of respect for autonomy on its own requires that assisted suicide be permitted in some circumstances.
Having considered assisted suicide alongside other end-of-life practices in healthcare, the Committee considers that assisted suicide is ethically and legally distinct from practices such as the cessation of life-sustaining treatment and the administration of painkilling drugs which incidentally hasten death, and that the reasons which justify these practices do not support or justify assisted suicide.